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It’s tick time. Summertime is the time of the year to enjoy the outdoors. It’s also the time when the habitats of children and ticks overlap. Whether you enjoy hiking or camping in the Great Smoky Mountains like my kids and I do or playing in the backyard with your kids and pets, you may be exposed to ticks. Ticks can transmit disease and depending where you live or visit in the USA, different diseases can be spread by tick bites.

Here in the Appalachian Mountains, the most common is Rocky Mountain Spotted Fever transmitted by the dog tick, which is about 1/2 inch in size. Over towards Nashville and the Cumberland Plateau, Ehrlichiosis is more commonly spread by a variety of ticks. In the Northeast and Upper Midwest, Lyme disease is the most commonly transmitted tick borne disease. It’s spread by the small tick called Ixodes scapularis which is about the size of a pinhead. All over the Southeast, there is a newer illness called STARI which is the Southern Tick Associated Rash Illness spread by the Lone Star tick – also about ½ inch in size.

Once a tick is attached and feeds on you for at least 72 hours, the little buggers can transmit these diseases. Most symptoms that you will encounter are fever, headache, nausea, muscle or joint pain and rash. Think of it as summertime flu symptoms. Most symptoms start anywhere from 2 to 14 days after the bite.

How can you help prevent tick bites? Be aware of the areas where ticks live. Most ticks prefer dense woods with thick growth of shrubs and small trees as well as along the edges of woods where the woods abut lawns. Ticks require humidity to survive, and drier areas usually are less infested. When outdoors your child should wear long-sleeved shirts tucked into his or her pants. The pants should be tucked into socks or boots. Use an insect repellent containing permethrin on clothing to repel ticks and other insects but don’t apply this to skin. DEET containing products from 5-30% helps prevent both ticks and mosquito but don’t use it on babies under 2 months of age. During a hike or camping, do tick checks using a buddy system every 4 hours. After a full day do a bare skin check and shower to remove any ticks that are not firmly attached.

Tick bites are painless and don’t itch. Favorite hiding places for ticks are in the hair, so check the scalp, neck, armpit and groin. To remove a tick, get a tweezer and apply pressure right behind the head and lift straight up after it releases. If any part of the tick is still there, scrape it off and then wash with soap and water. Also check your pets, especially dogs for ticks daily. You can save the tick for inspection later by keeping it in a glass jar. More on tick removal from the AAP.

Remember, if you develop any of these symptoms such as fever, rash or headache after a tick bite, please call your pediatrician’s office. How to treat tick bites.

Lichen striatus is a benign and self limited rash that occurs in children anywhere from 5 to 15 years in 50 % of cases. However, my daughter was 2 years old when she suddenly had this rash appear on the back of her right leg. Females tend to be more affected by this than males. There is no known cause for this rash except possibly some environmental and genetic factors. Below are more details about this rash as per www.dermnetnz.org :

What does lichen striatus look like? Lichen striatus starts as small pink, red or flesh colored spots that over the course of one or two weeks join together to form a dull red slightly scaly linear band. The band is usually 2 mm to 2 cm in width and may be a few centimeters in length or may extend the entire length of the limb. Sometimes there are two parallel bands. Lesions occur most commonly on one arm or leg but can affect the neck or trunk. Sometimes a band may extend from the leg onto the buttock or abdomen. Usually there are no symptoms but some patients may complain of slight or intense itching. Occasionally nails may be affected, sometimes without any skin lesions. They become thick, ridged, split and may rarely fall off altogether.

How is lichen striatus diagnosed? Lichen striatus is diagnosed by its typical clinical appearance. Findings on histopathology of a skin biopsy may also be helpful.

What treatments are available for lichen striatus? There is no effective treatment for lichen striatus and in most cases none is necessary. It usually resolves within 6 months but may leave temporary pale or dark marks (hypopigmentation or hyperpigmentation).What does lichen striatus look like? Emollients may be used to help treat dryness or itching, if present. Topical steroids or pimecrolimus cream may clear the lesions although they may take some weeks to be effective.

My daughter’s rash started as a group of palpable pink spots on the back of her thigh. From that patchy rash extended a linear strand that led to a similarly patchy red rash all over her posterior calf. The bigger patches were slightly itchy at times. Her rash lasted about a month and did not leave any hypopigmented areas. Below are 2 pictures of my daughter’s rash on the back of her right leg.

If you have questions or if your child has a rash, please call your pediatrician’s office.